Evaluation of the Implementation Outcomes of the Framework and Strategy for Disability and Rehabilitation for South Africa: An Explanatory Mixed-Methods Study

Abstract

Background Disability remains a global challenge, affecting 15% of the population worldwide and 7.5% in South Africa. The increase in disability poses significant implications for the healthcare system, exacerbated by a quadruple burden of disease and systemic inequalities. To address these challenges, South Africa introduced the Framework and Strategy for Disability and Rehabilitation (FSDR) (2015–2020, extended to 2023) to align with international disability rights frameworks, such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). The FSDR has not been evaluated to assess its implementation outcomes, limiting opportunities to inform future policy. Aim This study evaluated the implementation outcomes of the Framework and Strategy for Disability and Rehabilitation (FSDR) in Gauteng Province by assessing provincial processes, exploring stakeholder perceptions, and mapping influencing factors. This study aimed to develop evidence-based strategies to enhance the implementation of future disability and rehabilitation policies in South Africa. Methods The study employed an explanatory mixed-methods design that integrated quantitative and qualitative approaches. A document review analysed provincial reports on FSDR implementation, while semi-structured interviews and focus group discussions captured the experiences of key stakeholders, including rehabilitation professionals, policymakers, and community representatives. Data was analysed thematically and categorised using Proctor’s Model, the Consolidated Framework for Implementation Research (CFIR), the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the ERIC Framework. Key Findings The evaluation revealed a mixed picture of the successes and challenges of implementing the FSDR. Key barriers include inadequate funding, limited rehabilitation resources, paucity of skilled personnel, and systemic inefficiencies in referral systems. Stakeholders also cited poor inter-sectoral collaboration and lack of standardised training as critical issues. However, the study also identified enabling factors, such as the involvement of disability advocacy organisations, the alignment of the FSDR with global disability rights goals, and the role of community-based rehabilitation initiatives. The study proposed implementation strategies to improve disability and rehabilitation policies, including optimising resource allocation, enhancing capacity-building for healthcare professionals, vi and promoting inter-sectoral collaboration. It also emphasised the need for thorough monitoring and evaluation mechanisms to ensure effective implementation and track progress. Conclusion This study highlights the critical importance of evaluating health policy implementation to ensure its alignment with stakeholder needs and global standards. By addressing the barriers identified in FSDR implementation, South Africa can strengthen its commitment to inclusive healthcare and advance the rights and well-being of persons with disabilities. Implications The findings of this study contribute to the growing body of knowledge regarding the implementation of science and disability policy. Evidence-based recommendations offer a roadmap for policymakers to improve rehabilitation services and address systemic barriers to equitable healthcare. These strategies aim to uphold the rights of persons with disabilities, reduce health disparities, and enhance the integration of rehabilitation services into South Africa’s health care system.